Estimating dose-response for time to remission with instrumental variable adjustment: the obscuring effects of drug titration in Genome Based Therapeutic Drugs for Depression Trial (GENDEP): clinical trial data

Semiparametric predictive inference for failure data using first-hitting-time threshold regression

The progression of disease for an individual can be described mathematically as a stochastic process. The individual experiences a failure event when the disease path first reaches or crosses a critical disease level. This happening defines a failure event and a first hitting time or time-to-event, both of which are important in medical contexts. When the context involves explanatory variables then there is usually an interest in incorporating regression structures into the analysis and the methodology known as threshold regression comes into play. To date, most applications of threshold regression have been based on parametric families of stochastic processes. This paper presents a semiparametric form of threshold regression that requires the stochastic process to have only one key property, namely, stationary independent increments. As this property is frequently encountered in real applications, this model has potential for use in many fields. The mathematical underpinnings of this semiparametric approach for estimation and prediction are described. The basic data element required by the model is a pair of readings representing the observed change in time and the observed change in disease level, arising from either a failure event or survival of the individual to the end of the data record. An extension is presented for applications where the underlying disease process is unobservable but component covariate processes are available to construct a surrogate disease process. Threshold regression, used in combination with a data technique called Markov decomposition, allows the methods to handle longitudinal time-to-event data by uncoupling a longitudinal record into a sequence of single records. Computational aspects of the methods are straightforward. An array of simulation experiments that verify computational feasibility and statistical inference are reported in an online supplement. Case applications based on longitudinal observational data from The Osteoarthritis Initiative (OAI) study are presented to demonstrate the methodology and its practical use.

Accounting for delayed entry into observational studies and clinical trials: length-biased sampling and restricted mean survival time

Individuals in many observational studies and clinical trials for chronic diseases are enrolled well after onset or diagnosis of their disease. Times to events of interest after enrollment are therefore residual or left-truncated event times. Individuals entering the studies have disease that has advanced to varying extents. Moreover, enrollment usually entails probability sampling of the study population. Finally, event times over a short to moderate time horizon are often of interest in these investigations, rather than more speculative and remote happenings that lie beyond the study period. This research report looks at the issue of delayed entry into these kinds of studies and trials. Time to event for an individual is modelled as a first hitting time of an event threshold by a latent disease process, which is taken to be a Wiener process. It is emphasized that recruitment into these studies often involves length-biased sampling. The requisite mathematics for this kind of sampling and delayed entry are presented, including explicit formulas needed for estimation and inference. Restricted mean survival time (RMST) is taken as the clinically relevant outcome measure. Exact parametric formulas for this measure are derived and presented. The results are extended to settings that involve study covariates using threshold regression methods. Methods adapted for clinical trials are presented. An extensive case illustration for a clinical trial setting is then presented to demonstrate the methods, the interpretation of results, and the harvesting of useful insights. The closing discussion covers a number of important issues and concepts.

Group sequential design for randomized trials using "first hitting time" model

Group sequential design (GSD) has become a popular choice in recent clinical trials as it improves trial efficiency by providing options for early termination. The implementation of traditional tests for survival analysis (eg, the log-rank test and the Cox proportional hazard (PH) model) in the GSD setting has been widely discussed. The PH assumption is required for conventional (sequential) design, it is, however, often violated in practice. As an alternative, some generalized tests have been proposed (eg, the Max-Combo test) and their efficacies have been established. In this article, we explore the application of a more flexible, "first hitting time" based threshold regression (TR) model to GSD. TR assumes that subjects' health status is a latent (unobservable) process, and the clinical event of interest occurs when the latent health process hits a pre-specified boundary. The simulation results supported our findings that, in most cases, this comparable new method can successfully control type I error while providing higher early stopping opportunities in the sequential design, even when non-proportional hazard presents.

Multivariate Threshold Regression Models with Cure Rates: Identification and Estimation in the Presence of the Esscher Property

The first hitting time of a boundary or threshold by the sample path of a stochastic process is the central concept of threshold regression models for survival data analysis. Regression functions for the process and threshold parameters in these models are multivariate combinations of explanatory variates. The stochastic process under investigation may be a univariate stochastic process or a multivariate stochastic process. The stochastic processes of interest to us in this report are those that possess stationary independent increments (i.e., Lévy processes) as well as the Esscher property. The Esscher transform is a transformation of probability density functions that has applications in actuarial science, financial engineering, and other fields. Lévy processes with this property are often encountered in practical applications. Frequently, these applications also involve a ‘cure rate’ fraction because some individuals are susceptible to failure and others not. Cure rates may arise endogenously from the model alone or exogenously from mixing of distinct statistical populations in the data set. We show, using both theoretical analysis and case demonstrations, that model estimates derived from typical survival data may not be able to distinguish between individuals in the cure rate fraction who are not susceptible to failure and those who may be susceptible to failure but escape the fate by chance. The ambiguity is aggravated by right censoring of survival times and by minor misspecifications of the model. Slightly incorrect specifications for regression functions or for the stochastic process can lead to problems with model identification and estimation. In this situation, additional guidance for estimating the fraction of non-susceptibles must come from subject matter expertise or from data types other than survival times, censored or otherwise. The identifiability issue is confronted directly in threshold regression but is also present when applying other kinds of models commonly used for survival data analysis. Other methods, however, usually do not provide a framework for recognizing or dealing with the issue and so the issue is often unintentionally ignored. The theoretical foundations of this work are set out, which presents new and somewhat surprising results for the first hitting time distributions of Lévy processes that have the Esscher property.